Pelvic floor training and hormone therapy

Urinary incontinence is a prevalent condition among women of all ages and has a considerably negative effect on quality of life.

In a recent study1, education about the pelvic floor muscles made women more aware about the pelvic floor muscles' functions and potential dysfunctions, but this was not a substitute for pelvic floor muscle training with a physiotherapist. In a new study, pelvic floor muscle training for post-menopausal women by a physiotherapist significantly increased pelvic floor muscle strength (by 4.5 cmH2O), and significantly decreased the prevalence of urinary incontinence (OR 0.36).

However, these benefits have been observed before and were not the main focus of the new study. Instead, the new study, which involved investigators from Brazil, Australia and Norway, focused on whether the use of hormone replacement therapy had any influence on the amount of benefit obtained from the pelvic floor muscle training.

The influence of hormone replacement therapy is a matter of controversy because of conflicting results from previous studies.

It has been suggested that oestrogen may play an important role in pelvic floor muscle function. According to some authors, oestrogen therapy or combined therapy (oestrogen and progesterone) partially prevents age-related sarcopenia and may even restore muscle function lost during the onset of menopause.

One small study seemed to support that notion, whereas other larger studies suggested the opposite. All of these studies provided indirect evidence but did not have as their main focus determining the influence of concomitant hormone therapy on the benefits of pelvic floor muscle training,

In the new study, 99 post-menopausal women (38 of whom were using daily systemic oestrogen/ progestogen therapy) were randomised to the pelvic floor muscle training or control group. As discussed above, the benefits of pelvic floor muscle training occurred as anticipated.

However, these benefits were significantly smaller among those women who were using hormone therapy. Pelvic floor muscle training increased pelvic floor muscle strength by 8.0 cmH2O (95% CI 3.4 to 12.6) in women not using hormone therapy and there was a mean decresed of 0.9 cmH20 (95% CI –6.5 to 4.8) in women using hormone therapy.

There was also a significantly greater effect of training in women not using hormone therapy on prevalence of urinary incontinence symptoms (ratio of odds ratios = 7.4), although this may have been due to baseline differences in the prevalence of incontinence symptoms.

The mechanism by which systemic combined hormonal therapy could influence the prevalence of urinary incontinence is not well established. 2 high-quality randomised, controlled trials and a systematic review have indicated that hormone therapy increases the risk of both stress and urgency urinary incontinence.

The main indications for prescribing hormone therapy for postmenopausal women are moderate to severe hot flushes, vaginal dryness, fatigue, irritability, sleep disturbance, and depression. Women may wish to consider the pros and cons of hormone therapy with the the findings of this new study in mind.

Want to read deeper into this topic? Have a look at the free full text version of this article published in Journal of Physiotherapy!

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